N.J. Admin. Code § 10:60-3.1

Current through Register Vol. 56, No. 24, December 18, 2024

Section 10:60-3.1 - Purpose and scope

(a) Personal care assistant services shall be provided by a certified licensed home health agency, a certified hospice agency or by a health care service firm that is accredited, initially, and on an on-going basis, by an accrediting body approved by DMAHS.

(b) Personal care assistant services include health-related tasks associated with the cueing, supervision, and/or completion of the activities of daily living (ADL), as well as instrumental activities of daily living (IADL) related tasks performed by a qualified individual in a beneficiary's place of residence or place of employment, or at a post-secondary educational or training program, under the supervision of a registered professional nurse, certified as medically necessary by a physician/practitioner in accordance with a written plan of care. These services are available from a home health agency, hospice agency, or a health care services firm. The purpose of personal care assistant services is to accommodate long-term chronic or maintenance health care, as opposed to short-term skilled care required for some acute illnesses.

1. Personal care assistant services are those services described at N.J.A.C. 10:60-3.3(a)1.

2. Instrumental activities of daily living are those activities described at N.J.A. C. 10:60-3.3(b).

3. Health related tasks are those services described at N.J.A.C. 10:60-3.3(a)3.

4. A qualified individual is a person who is a personal care assistant, as the term is defined at N.J.A.C. 10:60-1.2.

(c) In order to qualify for PCA services, beneficiaries must be in need of moderate, or greater, hands-on assistance in at least one activity of daily living (ADL), or, minimal assistance or greater in three different ADLs, one of which must require hands-on assistance.

1. Assistance with IADLs, such as meal preparation, laundry, housekeeping/cleaning, shopping, or other non-hands-on personal care tasks shall not be permitted as a stand-alone PCA service.

2. When a beneficiary lives with a legally responsible relative, the LRR is expected to provide assistance with non-hands-on IADL care tasks that benefit the household as a whole, such as household/cleaning of shared living spaces, laundry of common use items, shopping for items to be shared among household members, such as cleaning supplies or food for shared meals, and meal preparation.

N.J. Admin. Code § 10:60-3.1

Amended by 50 N.J.R. 1992(b), effective 9/17/2018

Amended by 54 N.J.R. 1721(a), effective 9/6/2022